New funding system for adult social care is affordable, says Dilnot

BMJ 2011; 343 doi: (Published 28 November 2011) Cite this as: BMJ 2011;343:d7689
  1. Matthew Limb
  1. 1London

The UK government can afford to bring in a new funding system for adult social care and current economic woes should not be an excuse for inaction, says a leading economist.

Andrew Dilnot, whose Commission on Funding of Care and Support reported to ministers earlier this year (BMJ 2011;343:d4261, doi:10.1136/bmj.d4261), said it was “nonsense” to suggest reform was too expensive.

How much the country spends—as individuals or collectively through the state—was a matter of choice, not affordability, he told the King’s Fund annual conference in London on 23 November.

Mr Dilnot said he was sure ministers, who have yet to act on his recommendations, would “listen,” saying, “The government has little choice but to do something. I’d be cross if they did nothing.”

The number of older people in he UK is rising—there are 1.47 million people aged more than 85 now compared with 61 000 in 1901—a 25 times increase, the conference in London heard.

Mr Dilnot said society had adapted to cope with these rising numbers and it was wrong for policymakers to talk about the “burden of ageing” when it was a “triumph.”

The commission’s report, published in July 2011, criticised the current system of funding of adult social care in England as unfair and unnecessarily complex.

Mr Dilnot told the conference that some three quarters of people would need long term care before they died but there was no way of pooling that risk.

As a result, many people lived in fear of being liable for massive social care costs as they got older. “It’s the only risk like that and people feel terrified—they’re right to feel terrified,” he told the conference.

He said the current funding system was “mind numbingly inefficient,” exposed some people to potentially catastrophic care costs, and encouraged cheating to escape means testing. The means tested threshold, above which people are liable for their full care costs, should be increased from £23 250 (€27 000; $35 900) to £100 000, he said.

Mr Dilnot called for a new partnership model, under which individuals would pay up to a maximum of £35 000 towards care costs and be eligible for full state support beyond that.

He said it was only right the state should pool risks for the potentially high cost of care in later life because costs were too big and uncertain for the private insurance sector to step in.

He said the reform would cost a fraction of total public sector spending in the UK of £697bn. “All I’m asking for is £1.7bn a year . . . for something that affects three quarters of us . . . where people are living in miserable circumstances.

“The problem is not going to go away. The problem of the need for care in older age is going to be with us,” he said.


Cite this as: BMJ 2011;343:d7689

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